Position paper
Published: 2021-07-23
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Biologics for severe uncontrolled chronic rhinosinusitis with nasal polyps: a change management approach. Consensus of the Joint Committee of Italian Society of Otorhinolaryngology on biologics in rhinology

Fondazione Policlinico Universitario A. Gemelli IRCCS, Head and Neck Surgery – Otorhinolaryngology, Rome, Italy
ENT Department, San Camillo-Forlanini Hospital, Roma, Italy
ENT Unit, Vito Fazzi Hospital, ASL Lecce, Italy
ENT Unit Department of Medical and Surgical Sciences, University Magna Græcia Catanzaro, Italy
ENT University of Insubria, Varese, ASST Settelaghi, Italy
IRCCS Humanitas Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Rozzano, Milan, Italy
Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy
ENT Department, I.R.C.C.S. Policlinico San Matteo- University of Pavia, Italy
Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
IFOS Former President and Executive Board member, Rome, Italy
type 2 inflammation chronic rhinosinusitis with nasal polyps biologics endoscopic sinus surgery endotyping

Abstract

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory condition of nasal mucosa and paranasal sinuses, predominantly mediated by type 2 inflammation and often associated with comorbid asthma and/or Exacerbated Respiratory Disease (N-ERD). The standard of care involves local and systemic corticosteroids and/or sinonasal surgery, although these options may be associated with recurrences and patients may require revision surgery. Difficult-to-treat patients, in fact, have a more severe disease requiring high systemic corticosteroid use and/or multiple sinonasal surgeries. Literature data suggests that biologic agents targeting specific key effectors of type 2 inflammation may offer supplemental therapy for patients with severe and uncontrolled CRSwNP, leading to significant improvement in several outcomes. For these reasons, over the years the endotyping of the disease has become increasingly important. Herein, we provide not only an update on the existing studies about the most promising biologics in CRSwNP, but also critical discussion on controversies about the use of biologics in severe uncontrolled CRSwNP. We finally provide consensus on strategic issues gathered among experts of the Joint Committee of Italian Society of Otorhinolaryngology on biologics in order to offer the best care for difficult to treat patients.

Affiliations

Eugenio De Corso

Fondazione Policlinico Universitario A. Gemelli IRCCS, Head and Neck Surgery – Otorhinolaryngology, Rome, Italy

Gianluca Bellocchi

ENT Department, San Camillo-Forlanini Hospital, Roma, Italy

Michele De Benedetto

ENT Unit, Vito Fazzi Hospital, ASL Lecce, Italy

Nicola Lombardo

ENT Unit Department of Medical and Surgical Sciences, University Magna Græcia Catanzaro, Italy

Alberto Macchi

ENT University of Insubria, Varese, ASST Settelaghi, Italy

Luca Malvezzi

IRCCS Humanitas Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Rozzano, Milan, Italy

Gaetano Motta

Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy

Fabio Pagella

ENT Department, I.R.C.C.S. Policlinico San Matteo- University of Pavia, Italy

Claudio Vicini

Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy

Desiderio Passali

IFOS Former President and Executive Board member, Rome, Italy

Copyright

© Società Italiana di Otorinolaringoiatria e chirurgia cervico facciale , 2021

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